Best Practices in the Management of IBD During COVID-19 - Episode 6

Inflammatory Bowel Disease: Treatment Advances

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Miguel Regueiro, MD: Let’s pivot for a minute. I’m going to come back to COVID-19 [coronavirus disease 2019], but I want to get into it because we have a wide audience looking at us.

Doug, I’m going to ask you: What are the medicines available for IBD [inflammatory bowel disease] on a biologic, small-molecule sense? With the approved medicines for each, you can label which is Crohn disease and which is ulcerative colitis. Then Jean-Fred, I’m going to ask you a few questions about the studies, not any high-level detailed percentages but overall about what the studies looked at. We’ll then come back to some questions about COVID-19. Doug, today, in 2020, what are the biologics and small molecules approved for inflammatory bowel disease?

Douglas C. Wolf, MD: Thank you. We’ll start with Crohn disease. There is infliximab, or Remicade, and there are biosimilars too that I’ll mention that aren’t used much. Remicade is the mainstay for complicated Crohn disease or hospitalized Crohn disease. Humira [adalimumab] has been around for a long time, and I put that up on the table with patients. All this is done as part of a shared decision-making discussion about treatment options.

There is also another anti-TNF [tumor necrosis factor]: Certolizumab pegol is sometimes used, but the newest agent on the block in Crohn disease is vedolizumab.

Vedolizumab is an IV [intravenous] induction maintenance therapy, and hopefully in the next year it will be available as subcutaneous maintenance as well. That is being evaluated. There is also ustekinumab, which is an excellent agent for Crohn disease. It is 1 dose of intravenous induction therapy followed by subcutaneous maintenance. We’ve got a lot of great options, and I tell every patient I see that they’re fortunate if they’re diagnosed with IBD in 2020 because there are many excellent options that are not steroids. Beyond that, we understand how to use these agents much better than we did 10 or 20 years ago when they came out.

For ulcerative colitis, the options are similar but not identical. We have infliximab. We have adalimumab. We have golimumab, and then we have vedolizumab and ustekinumab available as well. We also have 1 small molecule that is available: tofacitinib. I could keep going, but I will defer to the true expert to go on and tell us more about them.

Transcript Edited for Clarity